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Challenges Specific to the Feline Cancer Patient
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Erika Krick
DVM, Dipl. ACVIM (Oncology)
Dr Krick received her veterinary training at the University of Pennsylvania School of Veterinary Medicine and completed a rotating internship in Small Animal Medicine and Surgery and a residency in Medical Oncology at the school before joining the veterinary faculty in 2009. She is currently an assistant professor of Oncology and chief of the section of Oncology, with research focused on feline lymphoma and cancer cachexia; her primary teaching interests are clinical oncology and communication skills.
Key Points
- Many cancers in cats differ in their clinical behavior, treatment recommendations, and prognosis when compared to similar cancers in other species. The approach to feline neoplasia should therefore be based on species-specific information.
- Clear communication with an owner regarding treatment options and their feasibility, and careful management of the owner’s expectations, will result in improved adherence to clinical recommendations.
- Cats with lymphoma are often ill at the time of diagnosis, and maintaining a good quality of life during treatment depends on supportive care as well as cytotoxic therapy.
- The hallmark of cachexia is loss of muscle mass, while loss of adipose tissue is indicative of inadequate caloric intake; both body muscle and body fat should be assessed in the feline cancer patient.
Introduction
Cancer treatment of both cats and dogs has been on the rise both in specialty and primary care practices. For example, a survey of UK veterinary practices showed that 70.8% had used cytotoxic therapy in the past year, and 39.6% had referred a patient to another practice for such treatment (1). The most commonly prescribed drugs were cyclophosphamide (92.4% of practices) and vincristine (89.6%), followed by chlorambucil (42.8%) and doxorubicin (30.1%), and given the frequency of lymphoma in animals, it is not surprising that these drugs are the most often prescribed.
When compared to other domestic animals (and humans), cats are unique in many ways – they are obligate carnivores, they are predators, many bear a striking resemblance to their larger, wilder relatives in both appearance and behavior, and for the most part their body size is relatively uniform across breeds. Their cancers are unique as well, which must be taken into account when considering treatment options. One example is feline lymphoma, which can manifest in several different forms; unlike other species, cats rarely develop multicentric lymphoma, but frequently develop the intestinal form of the disease. The treatment options and prognostic expectations vary depending on the type of lymphoma. Other examples are appendicular osteosarcoma, which (in contrast to dogs) rarely metastasizes in the cat, and splenic mast cell disease, which is quite treatable. However, this article does not focus on specific feline cancers, but rather will review the challenges that can arise when treating a cat with cancer.
Diagnosis and staging
The process of diagnosing cancer in cats is similar to other species, and the staging tests are similar as well. Depending on the type of cancer and the clinical status of the patient, cytology or biopsy may be the recommended procedure, and there are several options for obtaining samples (2), depending on the location of the organ or mass in question (i.e., fine-needle aspiration, incisional/excisional biopsy, endoscopy, laparoscopy, or exploratory abdominal surgery). Other diagnostic investigations depend on the differential diagnoses, findings on physical examination, results of any initial tests performed, and the patient’s status.
As with other species, the recommended staging tests for feline cancer depend on the diagnosis. For cats who are clinically ill and ultimately diagnosed with cancer, this may have already been performed as part of the diagnostic work-up, and no additional staging may be necessary. It is, however, recommended to perform feline leukemia virus testing on cats with lymphoma. In addition, the majority of cats with small cell lymphoma are cobalamin-deficient, so measurement of serum cobalamin is recommended, with subsequent supplementation if indicated (3). [...]
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